Pancreatic abscess demands prompt haemodynamic assessment and early, structured fluid management. The initial resuscitation strategy is tailored to the patient's volume status at presentation and monitored closely over the first 24–48 hours.
Management centres on moderately aggressive intravenous fluid resuscitation. Lactated Ringer solution is preferred over normal saline as the resuscitation fluid. The specific approach — including how fluid is titrated depending on volume status — is outlined in the full protocol.
Fluid volumes are reassessed at defined intervals within the first 6 hours of presentation and over the subsequent 24–48 hours. The key clinical endpoints are a measurable decrease in BUN — reflecting improved renal perfusion — and a decrease in haematocrit (haemodilution), both associated with reduced morbidity and mortality.
DOI: 10.14309/ajg.0000000000002645
We suggest moderately aggressive fluid resuscitation for patients with AP.
We suggest using lactated Ringer solution over normal saline for intravenous resuscitation in AP (conditional recommendation, low quality of evidence).
Additional boluses will be needed if there is evidence of hypovolemia (conditional recommendation, low quality of evidence).
Fluid volumes need to be reassessed at frequent intervals within 6 hours of presentation and for the next 24–48 hours with a goal to decrease the BUN.
In general, intravenous hydration providing for a decrease in the HCT (hemodilution) and/or decreased BUN (increased renal perfusion) have been shown to be associated with decreased morbidity and mortality.
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